Postpartum and nonpostpartum depression: Differences in presentation and response to pharmacologic treatment

Abstract

Following childbirth, major depression (postpartum depression) affects approximately 8–12% of new mothers. However, little is known about the pharmacological management of postpartum depression, and no studies to date have assessed differences in treatment response between women with postpartum and nonpostpartum major depression The authors reviewed the records of 26 women with postpartum major depression and 25 women with major depression unrelated to childbearing (nonpostpartum depression) who presented to them for treatment over a 4‐year period. Compared with the nonpostpartum depressed patients, the postpartum depressed women were significantly more likely to present with anxious features. Also, cases of postpartum depression were more severe than cases of nonpostpartum depression. While the postpartum patients were equally as likely to recover (as defined by a Clinical Global Impression score of 1 or 2) compared to the nonpostpartum‐depressed patients, their time to response was significantly longer. By 3 weeks of pharmacotherapy, 75% of the nonpostpartum cases had recovered, in contrast to only 36% of the postpartum cases. Further, postpartum patients were significantly more likely to be receiving more than one antidepressant agent at the time of response to treatment. Length of depression prior to treatment did not explain the difference in treatment response. Presence of depressive symptoms during pregnancy and timing of onset of the depression (before vs. after 4 weeks of delivery) did not affect likelihood of treatment response in this sample Women with postpartum depression appear to be significantly more likely than the nonpostpartum women to present with anxious features, take longer to respond to pharmacotherapy for depression, and require more antidepressant agents at the time of response to treatment. Depression and Anxiety 11:66–72, 2000. © 2000 Wiley‐Liss, Inc

A Postpartum Model in Rat: Behavioral and Gene Expression Changes Induced by Ovarian Steroid Deprivation

“…The elevated anxiety observed in the EPM is in line with the clinical features of PPD; women with PPD are more likely to present with anxious features compared with patients with nonpostpartum depression (35). This finding is also supported by animal studies demonstrating that pseudopregnant rats that undergo estrogen and progesterone withdrawal display an enhanced level of anxiety (36).…”

An Update on Mood and Anxiety Disorders During Pregnancy and the Postpartum Period

“…Compared with depression occurring at other times in women's lives, postpartum depression is frequently complicated by prominent anxious features. 41 Large and carefully controlled studies in the 6 to 12 weeks after delivery report rates of maternal depression at 12% to 16%. [42][43][44] The overlap of depressive symptoms with those of normal childbirth sequelae can confound the clinical identification of postpartum depression.…”

Transtornos psiquiátricos no pós-parto

“…No quadro clínico da depressão nessa época da vida são observadas algumas peculiaridades 20 , dentre elas a alta probabilidade de comorbidade com sintomas ansiosos 21,22 e obsessivo-compulsivos [23][24][25] , a menor incidência de suicídio 26 e a resposta terapêutica mais demorada e requerendo mais de uma medicação 27 . As mulheres com DPP têm mais chance de apresentar episódios depressivos posteriormente e principalmente novos episódios de DPP 28 .…”